BACKGROUND Treatment-resistant depression is among the most debilitating conditions in psychiatry. Recent studies have associated alterations in white matter microstructure measured with magnetic resonance imaging with poor antidepressant response. Therefore, the extent to which electroconvulsive therapy, the most effective therapeutic option for treatment-resistant depression, affects white matter microstructure warrants investigation. METHODS A total 13 patients suffering from severe unipolar treatment-resistant depression underwent magnetic resonance imaging with a diffusion tensor imaging sequence before and after undergoing a series of right unilateral electroconvulsive therapy. Diffusivity metrics were compared voxel-wise using tract-based spatial statistics and repeated-measures ANOVA. RESULTS A total 12 patients responded to electroconvulsive therapy and 9 were classified as remitters. An increase in axial diffusivity was observed in the posterior limb of the internal capsule of the right hemisphere (PFWE ≤ .05). The increase in this area was higher in the right compared with the left hemisphere (P < .05). No correlation of this effect with treatment response could be found. CONCLUSIONS The strong lateralization of effects to the hemisphere of electrical stimulation suggests an effect of electroconvulsive therapy on diffusivity metrics which is dependent of electrode placement. Investigation in controlled studies is necessary to reveal to what extent the effects of electroconvulsive therapy on white matter microstructure are related to clinical outcomes and electrode placement.

中文翻译：

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抗惊厥性电痉挛治疗后白色物质微结构的变化。

背景技术抗治疗性抑郁症是精神病学中最使人衰弱的病症之一。最近的研究表明，用核磁共振成像测得的白质微结构变化与抗抑郁药反应差有关。因此，电痉挛疗法是抵抗抑郁症最有效的治疗选择，在多大程度上影响白质微观结构，值得研究。方法总共13例患有严重单极治疗性抑郁症的患者，在接受一系列正确的单侧电抽搐治疗前后，均接受了具有弥散张量成像序列的磁共振成像。使用基于区域的空间统计数据和重复测量方差分析，以体素方式比较了扩散度指标。结果共有12例患者对电惊厥治疗有效，其中9例归为缓解者。观察到右半球内囊后肢的轴向扩散性增加（PFWE≤.05）。与左半球相比，右侧该区域的增加更大（P <.05）。没有发现这种效应与治疗反应的相关性。结论对电刺激半球的强烈偏侧化提示电抽搐治疗对扩散率指标的影响，该指标取决于电极的位置。必须进行对照研究以揭示电惊厥疗法对白质微观结构的影响在多大程度上与临床结果和电极放置有关。